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Heart Disease (Expert Forum)
Confused about diagnosis.
This forum is for questions and support regarding heart issues such as: Angina, Angioplasty, Arrhythmia, Bypass Surgery, Cardiomyopathy, Coronary Artery Disease, Defibrillator, Heart Attack, Heart Disease, High Blood Pressure, Mitral Valve Prolapse, Pacemaker, PAD, Stenosis, Stress Tests.
Confused about diagnosis.
by JtOhio, Mar 12, 2003 12:00AM
I'm 25, non-smoker.Symptoms beginning in 2000: BP of 140/90 (as of 1998 it was 116/75) and PVCs. Cholesterol is 130, with 3.5 ratio.
7/2000: Echo:normal LV, EF of 70%. LA,RA,AV,Tricuspid all normal... GRADE INSUFF. OF MV: TRACE. 'Mitral valve motion at times is minimally suggestive of MR - not be of any clinical significance'.
12/2002: Stress Cardiolite (I was still having symptoms). Pre-excersise conclusions:'Good Excersise Tolerance', 'Negative, adequate stress EKG for ischemia'. 10 minutes 30 seconds (stopping due to general fatigue), peak HR of 184BPM. No ST depression noted. Post-excersise spect images show a mild defect in the uptake of the inferior wall; rest images showed normal uptake. POST STRESS GATED CIDE: Slightly decreased thickening of the inferior wall by gated images. Conclusions of Post-Ex: 'Compatible with ischemia of inferior wall, no evidence of prior infarct, abnormal wall thickening as noted, EF of 75%'.
1/2003: Cardiac Cath performed. Everything looked great (no blockages); Stress Cardiolite was a false-pos. He said my EF during the cath was 50%. I questioned the EF being 50%, but he told me that they see EF %'s around 50% in athletic individuals with healthy hearts.
It's hard to believe that 'all is well':
1. The abnormal wall-thickening coinciding with a 'cool area' of the inferior wall in the post-stress perfusion images (even though this test is now thought to be a false positive). Could both the 'cool' area AND the wall-thickening be an artifact?
2. The 50% EF during the cath.
3. The trace MR in 7/2000.
Thank you!
7/2000: Echo:normal LV, EF of 70%. LA,RA,AV,Tricuspid all normal... GRADE INSUFF. OF MV: TRACE. 'Mitral valve motion at times is minimally suggestive of MR - not be of any clinical significance'.
12/2002: Stress Cardiolite (I was still having symptoms). Pre-excersise conclusions:'Good Excersise Tolerance', 'Negative, adequate stress EKG for ischemia'. 10 minutes 30 seconds (stopping due to general fatigue), peak HR of 184BPM. No ST depression noted. Post-excersise spect images show a mild defect in the uptake of the inferior wall; rest images showed normal uptake. POST STRESS GATED CIDE: Slightly decreased thickening of the inferior wall by gated images. Conclusions of Post-Ex: 'Compatible with ischemia of inferior wall, no evidence of prior infarct, abnormal wall thickening as noted, EF of 75%'.
1/2003: Cardiac Cath performed. Everything looked great (no blockages); Stress Cardiolite was a false-pos. He said my EF during the cath was 50%. I questioned the EF being 50%, but he told me that they see EF %'s around 50% in athletic individuals with healthy hearts.
It's hard to believe that 'all is well':
1. The abnormal wall-thickening coinciding with a 'cool area' of the inferior wall in the post-stress perfusion images (even though this test is now thought to be a false positive). Could both the 'cool' area AND the wall-thickening be an artifact?
2. The 50% EF during the cath.
3. The trace MR in 7/2000.
Thank you!
Doctor's Answer
by CCF-M.D.-KE, Mar 12, 2003 12:00AM
Dear Jtohio,
Sorry to hear about your ordeal. A person such as yourself who is 25 and has no cardiac risk factors has a very low pre-test probability of having coronary artery disease. This means that the incidence of coronary artery disease in people such as yourself is very low and if a test is suggestive of coronary artery disease, it is probably a false positive test. The inferior ischemia seen on your nuclear scan likely represented diaphragmatic attenuation. This means that the diaphragm may have prevented some the radioactive tracer from being detected in the inferior aspect of your heart. The findings you have described are very likely artifactual.
The ejection fraction obtained during the heart catheterization is likely a subjective finding, I would need to view the pictures to comment further.
Trace mitral regurgitation is a very common finding. It is nothing to be overly concerned about at this time.
Thanks for your question,
CCF-MD-KE
Sorry to hear about your ordeal. A person such as yourself who is 25 and has no cardiac risk factors has a very low pre-test probability of having coronary artery disease. This means that the incidence of coronary artery disease in people such as yourself is very low and if a test is suggestive of coronary artery disease, it is probably a false positive test. The inferior ischemia seen on your nuclear scan likely represented diaphragmatic attenuation. This means that the diaphragm may have prevented some the radioactive tracer from being detected in the inferior aspect of your heart. The findings you have described are very likely artifactual.
The ejection fraction obtained during the heart catheterization is likely a subjective finding, I would need to view the pictures to comment further.
Trace mitral regurgitation is a very common finding. It is nothing to be overly concerned about at this time.
Thanks for your question,
CCF-MD-KE
Member Comments (3)
by JtOhio, Mar 12, 2003 12:00AM
BTW - after the Cath, the doc said everything was fine and there is no cause for worry... he chalked up the entire Stress Cardiolite to a false-pos. I'm just really concerned with the abnormal wall-thickening coinciding with my 50% EF during the cath... even the cath results say 'Low-normal LV function'. How is this "nothing to be concerned about"?
by JtOhio, Mar 12, 2003 12:00AM
Thank you very much for your reply!
